As Ebola Spreads in Uganda, U.S. Imposes Traveler Screening

Much of this is reminiscent of the 2014-2016 outbreak, during which the US reported the first case outside Africa in a Liberian national who traveled to Dallas through four different airports without being stopped. At the time, NPR explained that “Ebola symptoms can lay dormant for two to 21 days, and during that time, the disease wouldn’t show up on a blood test, let alone a thermometer. There was no way to know that this particular passenger was at risk. The good news, says Thomas Frieden, director of the CDC: “Ebola doesn’t spread before someone gets sick, and he didn’t get sick till four days after he got off the airplane. So we do not believe there is any risk to anyone who was on the flight at that time.” Fever is one of the first symptoms to appear, so for now, thermometers remain a good way of catching infected travelers.”

The Liberian patient, Thomas Eric Duncan, died on the morning of October 8 at Texas Health Presbyterian Hospital in Dallas, a little over two weeks after he arrived in the US from West Africa. Two nurses who treated him, Nina Pham and Amber Vinson, were infected too, though they both later recovered. The hospital was later criticized in an independent report detailing miscommunication, poor information handling, and a lack of focus on patient safety that contributed to Duncan’s initial misdiagnosis and the nurses’ exposure. Later in October 2014, a medical aid worker who had volunteered in Guinea was hospitalized in New York City with suspected EVD, which was later confirmed by CDC. This patient also later recovered. An additional seven others were treated in the US after they were exposed and became ill while in West Africa, the majority of whom were medical workers. They were transported to the US on chartered aircraft. All but one recovered.

According to CDC, “The 2014-2016 Ebola epidemic was the first and largest epidemic of its kind, with widespread urban transmission and a massive death count of more than 11,300 people in Guinea, Liberia, and Sierra Leone. The epidemic took a devastating toll on the people of West Africa. Ending it took an extraordinary international effort in which the U.S. government played a major role.”

However, unlike this and other recent outbreaks, the cases in Uganda are of the Ebola Sudan strain. The WHO explains of this strain that “According to the International Classification of Disease for filoviruses (ICD-11) released in May 2019, Ebola disease is now sub-categorized depending on the causative virus. Outbreaks of Ebola disease caused by Sudan virus are named Sudan Virus Disease (SVD) outbreaks. Prior to May 2019 all viruses causing Ebola disease were grouped together. Based on the results of laboratory tests, this outbreak is caused by Sudan virus.”

“Sudan virus disease is a severe, often fatal illness affecting humans. Sudan virus was first reported in southern Sudan in June 1976, since then the virus has emerged periodically and up to now, seven outbreaks caused by SUDV have been reported, four in Uganda and three in Sudan. The estimated case fatality ratios of SVD have varied from 41% to 100% in past outbreaks.”

The WHO also explains that “The diagnosis of SVD can be difficult, as early nonspecific manifestation of the disease may mimic other infectious diseases such as malaria, typhoid fever and meningitis. Confirmation is made using numerous diagnostic methods including RT-PCR. Supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms improve survival.”

Importantly, in contrast to the Zaire strain, there are no licensed vaccines or therapeutics for this strain of Ebola. The CDC’s HAN advisory explains that “This is the fifth outbreak of EVD caused by Sudan virus in Uganda since 2000. The current outbreak is in the same area as Uganda’s most recent EVD outbreak caused by Sudan virus, which occurred in 2012. During the 2012 outbreak, limited secondary transmission was reported, and the outbreak was effectively contained.”

This article is published courtesy of the Pandora Report.